Insurance & Cost
Our office will accept and submit billing to in-network and out-of-network, primary and secondary insurance policies, that provide coverage for acupuncture and massage therapy. The following information may change without notice.
There are many groups within an insurance program, so we ask that you contact your insurance company and use our Financial Responsibility Research tool to confirm provider status with your insurance plan and group.
Injuries related to motor vehicle accidents are generally covered in full by the auto insurance policy’s P.I.P. component. Call your auto insurance agent to verify what your personal injury protection coverage is. No referral is required from your primary care physician.
Please call the office at (360) 366-4216 for our current cash rates.
Massage Therapy Prescriptions
Aetna, Cigna, Labor and Industry, Personal Injury claims, and Health Management Admin require massage prescriptions. Please list your primary care provider at time of your massage treatment, and we can acquire that prescription for you.
Most to no referral is required from your primary care physician for acupuncture services.
These plans do not cover acupuncture: DSHS, Washington Apple Health, Tricare, Medicaid, L & I, Worker’s Compensation, Medicare.
AETNA many plans only cover acupuncture for chronic low back pain, migraines, nausea & vomiting, osteoarthritis of the hip or knee, post-operative dental pain, temporomandibular joint dysfunction (TMJD). Please check on your particular plan.
CIGNA will only cover acupuncture for nausea & vomiting, post-operative dental pain, migraines, tension headaches, osteoarthritis of the hip and knee, neck pain, and back pain.
MODA HEALTH will only cover acupuncture for nausea & vomiting, post-operative dental pain, temporomandibular joint dysfunction (TMJD), neck pain, back pain, osteoarthritis of the hip and knee, migraines, and tension headaches.
Medicare does not cover acupuncture or massage therapy. Secondary policies to Medicare do not cover acupuncture, unless they specifically list acupuncture coverage in the policy. Call your secondary policy provider if you are unsure.
Medicaid, Tricare, V.A.:
Do not cover acupuncture. Our office has special rates for those who qualify.
In-Network Insurance Billing:
Insurance claims are delivered electronically, or in some cases by mail, from the provider’s office to the insurance company after each visit. Washington state law generally allows health insurance companies up to 30 days to process a claim after they receive it. The insurance company will send the client and the provider’s office an E.O.B., or explanation of benefits, after they process the claim. The provider’s office will then send the client a statement reflecting any outstanding balance or credit.
The E.O.B. shows CPT (Current Procedural Terminology) codes for services, procedures, and products in a format the insurance company requires for billing and claims. Single visits often require multiple CPT codes to comply with the insurance company’s requirement to specify services, procedures, and products; in terms of quantity, time, and/or type. For example: A 90 minute “new patient acupuncture” visit will often include 3 or more billing codes. These codes tell the insurance company what services, procedures, and/or products were provided to the client. Patient evaluation and assessment of a condition are coded separately from procedures, services, and/or products. Procedures often require two or more billing codes to indicate procedure type and time. Patient evaluation and assessment is performed on the initial visit, and then periodically to re-evaluate progress or to indicate that a new or different condition is being evaluated, assessed, and treated.
The E.O.B. also shows the amount billed for each CPT code, and the portion of the bill the client and insurance policy are responsible for. The amount billed for each CPT code is based on the “usual and customary rate” (UCR) in the geographic location of your provider’s office. All UCRs for any CPT code can be found at www.fairhealthconsumer.org.
In-network providers give negotiated discounts to insurance networks they contract with. In-network E.O.B. statements usually show an “adjustment” amount, which is a discount from the UCR. The “allowed amount” reflects the negotiated rate for each CPT code. The “patient portion” reflects the amount of the negotiated rate that is the patient’s responsibility to pay the provider. The “plan payment” amount reflects the insurance company’s portion of payment to the provider.
The most common CPT (Current Procedural Terminology) codes, billed in 15 minute segments, used by East Asian Medicine Practitioners / Licensed Acupuncturists are:
- 97810, 97811 (acupuncture without stimulation)
- 97813, 97814 (acupuncture with stimulation)
- 97140 (manual massage therapy)
- 96372 (point injection therapy)
- 97112 (neuromuscular reeducation)
- 97016 (gliding, stationary, fire cupping)
- 97032 (electrostimulation/scenar)
- 97026 (Infrared heat lamp)
- 99201, 99202, 99203 (new patient evaluation codes)
- 99211, 99212, 99213 (established patient evaluation codes)
The most common CPT codes, billed in 15 minute segments, used by Licensed Massage Practitioners are:
- 97124 (swedish massage)
- 97140 (manual massage therapy)
- 97010 (hot/cold therapy)
PROMPT PAY FEE – AVAILABLE ONLY AT TIME OF SERVICE
A “prompt pay fee” is only available if service is paid in full at time of service and office is not billing insurance. A prompt pay fee is a discounted cost of service which saves the facility time and administrative costs, as well as saves the patient money on medical bills. Those who qualify for this discounted service are:
- Those who would like to pay discounted rate for treatments.
- Those who do not have insurance coverage, thus no insurance billing is required.